Diverticulitis: The Daily PANCE Blueprint
A 61-year-old man presents with three days of left lower quadrant abdominal pain, low-grade fever, and constipation. He has had similar milder episodes before. On exam he is tender in the left lower quadrant with mild guarding but no rebound; his white-cell count is elevated. He is hemodynamically stable and tolerating sips of fluid. Which of the following is the most appropriate initial diagnostic test?
A. CT of the abdomen and pelvis with contrast
B. Colonoscopy now
C. Barium enema
D. Abdominal radiograph
E. Upper endoscopy
Answer and topic summary
The answer is A. CT of the abdomen and pelvis with contrast.
Left lower quadrant pain, fever, and leukocytosis in an older adult is acute diverticulitis until proven otherwise, and CT of the abdomen and pelvis with contrast is the initial test of choice — it confirms the diagnosis and reveals complications like abscess, obstruction, or perforation. The trap is colonoscopy: it is contraindicated during acute diverticulitis because insufflation raises the risk of perforating the inflamed, weakened bowel. Colonoscopy has an important role, but only after the acute episode resolves (about 6–8 weeks later) to exclude an underlying malignancy. Barium enema carries the same acute-phase perforation risk, plain films are insensitive, and upper endoscopy examines the wrong end of the gut.
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Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Colorectal Disorders ⇒ Diverticular Disease
